A new study is generating talk about the value of hospitalists and what they actually do for quality. Hospitalists, or hospital physicians dedicated to inpatient care, serve clinical positions, and oftentimes administrative, teaching, and leadership roles. Researchers at Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard University in Boston found that hospitals with hospitalists performed better than hospitals without.
"We now know for sure that, nationally, hospitals with hospitalists show better quality scores," said lead author Lenny Lopez, MD, MPH, hospitalist at Brigham and Women's Hospital, instructor at Harvard Medical School, and assistant in health policy at the Massachusetts General Hospital Institute for Health Policy.
Study details
The study, "Hospitalists and the Quality of Care in Hospitals," published in the August issue of Archives of Internal Medicine, looked at more than 3,600 hospitals in the country. It linked national measures from the Hospital Quality Alliance, under the Centers for Medicaid and Medicare Services, with data from the American Hospital Association, regarding three quality indicators: acute myocardial infarction, congestive heart failure, and pneumonia.
What researchers found was promising. Institutions that utilized hospitalists scored higher in two of the three quality markers: acute myocardial infarction and pneumonia, although there was no difference in congestive heart failure cases. Why?
Study authors believe that hospitalists link to quality but admit there may be other things inside the hospital at play.
"There are other things that contribute to high hospital scores," said Lopez about nurse staff ratios and health information technology. "Hospitalists are one of a series of things that improve overall quality; they are definitely a contributing factor," he said.
The legacy of hospital medicine
Proving the value of hospitalists has been a question since the inception of hospital medicine in 1996 when the word "hospitalist" was first coined: Do hospitalists improve care? Do they help the bottom line?
With more than 20,000 hospitalists in the U.S., according to the Society of Hospital Medicine, this practice is the fastest growing specialty in the nation. But it isn't always the most lucrative. These types of hospitals with hospitalists tend to be nonprofit, large, teaching facilities in southern states, according to the study, and often cater to non-procedure-based practice that includes the uninsured and underinsured population.
Previous studies have shown that hospitalists do, in fact, shorten patient length of stay, adhere to treatment guidelines, and give better follow up care. But are they really the ones to improve quality of care?
Yes, if they are good hospitalists, according to Robert Centor, MD, associate dean for the Huntsville Regional Medical Campus of the University of Alabama, School of Medicine, in Birmingham.
Hospitalists have been traditionally known for their consistency of care because they "live" in the hospital with varying work schedules and staffing levels.
"With their experience, they understand how the system runs, improve length of stay, improve revenue, and understand day-to-day operations," said Centor.
The good, the bad, and the average
Centor, editorial commenter on the study, would like to see what elements of hospitalist program structure make it successful.
"Forward-thinking hospitals have good hospitalist programs, but there is a difference between good and mediocre hospitals," said Centor. "If you hire people to look after patients but aren't involved in the processes or systems, then you don't have a hospitalist program, you have a bunch of hospitalists," he said.
Hospitalists worth the dollars?
In the end, many hospital administrators wonder if implementing a new or pursuing an existing hospitalist program will benefit the overall hospital.
"Hospitals that invest in hospitalists contribute to high quality," said Lopez. "The C-suite may need to supplement their clinical revenue [from other procedure based specialties], which translates into better quality care, which translates to better scores and higher rankings . . . that is a worthwhile investment," he said.
Centor adds, "It's an investment that pays off, but it is an investment."
Karen M. Cheung is associate editor at HCPro, Inc., and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.